Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
J Thorac Oncol. 2017 Jun;12(6):974-982. doi: 10.1016/j.jtho.2017.02.021. Epub 2017 Mar 7.
Stereotactic ablative radiotherapy (SABR) is currently not the guideline-recommended treatment for lung tumors measuring more than 5 cm. However, improvements in radiotherapy techniques have led to increasing use of SABR for larger tumors.
We analyzed the clinical outcomes in patients with a primary or recurrent NSCLC measuring more than 5 cm and treated with five or eight fractions of SABR at our center. Patients who had prior thoracic radiotherapy were excluded.
A total of 63 consecutive patients with a median tumor diameter of 5.8 cm (range 5.1-10.4) were identified; 81% had T2N0 disease and 18% had T3N0 disease. The median Charlson comorbidity index was 2 (range 0-6). After a median follow-up of 54.7 months, median survival was 28.3 months. Disease-free survival at 2 years was 82.1%, and the local, regional, and distant control rates at 2 years were 95.8%, 93.7%, and 83.6%, respectively. An out-of-field distant recurrence at one or more sites was the most common pattern of failure (10%). Grade 3 or higher toxicity was recorded in 30% of patients, with radiation pneumonitis being the most common toxicity (19%). A likely (n = 4) or possible (n = 8) treatment-related death was scored in 19% of patients. There was preexisting interstitial lung disease in eight patients (13%), with fatal toxicity developing in five of them (63%).
Lung SABR in tumors larger than 5 cm resulted in high local control rates and acceptable survival outcomes in a patient population with appreciable comorbidity. Patients with interstitial lung disease should be considered a very high-risk population for SABR.
立体定向消融放疗（SABR）目前不是指南推荐的用于测量超过 5 厘米的肺肿瘤的治疗方法。然而，放射治疗技术的改进导致越来越多的人将 SABR 用于更大的肿瘤。
我们分析了在我们中心接受 5 或 8 个分次 SABR 治疗的直径超过 5 厘米的原发性或复发性非小细胞肺癌患者的临床结果。排除了先前接受过胸部放疗的患者。
共确定了 63 例连续的肿瘤直径中位数为 5.8 厘米（范围为 5.1-10.4）的患者；81%为 T2N0 疾病，18%为 T3N0 疾病。中位 Charlson 合并症指数为 2（范围为 0-6）。中位随访 54.7 个月后，中位总生存期为 28.3 个月。2 年无病生存率为 82.1%，2 年局部、区域和远处控制率分别为 95.8%、93.7%和 83.6%。一个或多个部位的野外远处复发是最常见的失败模式（10%）。30%的患者记录了 3 级或更高的毒性，最常见的毒性是放射性肺炎（19%）。19%的患者发生了可能（n=4）或很可能（n=8）与治疗相关的死亡。8 例（13%）患者存在预先存在的间质性肺病，其中 5 例（63%）发生致命毒性。
对于合并症较多的患者，肺部 SABR 治疗大于 5 厘米的肿瘤可获得较高的局部控制率和可接受的生存结果。间质性肺病患者应被视为 SABR 的极高风险人群。
